At Hong Kong Hospitals, SARS Takes a Heavy Toll on NURSES

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    may 8, 2003, by keith bradsher

    at hong kong hospitals, sars takes a heavy toll on nurses

    hong kong, may 6 -- joanna pong, a 24-year-old registered nurse, has put up with a lot in nearly eight weeks of caring for sars patients here.

    she has had to move out of her parents' home and into the nurses' quarters next to the prince of wales hospital, for fear that she might otherwise infect her parents or someone along her bus ride to work.

    she must wear a mask when going on weekly dates with her boyfriend, and she seldom sees her friends any more.

    she has to wear a full-length, waterproof body suit, a disposable surgical gown, goggles, gloves and a tight-fitting mask for up to eight hours a day, an outfit that quickly becomes hot and sticky inside when she is moving around and then cold and clammy when she pauses.

    but the worst by far has been the fear, a constant dread that the slightest mistake, like touching her eyes with a virus-contaminated finger, could leave her as feverish and breathless as the patients she treats, and perhaps even kill her.

    "the most difficult part of the job is the psychological, not the physical," she said.

    while sars is not quite as terrifying as it was nearly two months ago, when scientists knew almost nothing about it, the disease remains extremely dangerous for nurses. despite many precautions, hundreds of nurses here and in other cities in asia and canada have been infected. two or three more health care workers, usually nurses, are still being infected in hong kong every day.

    indeed, there are signs here that sars, or severe acute respiratory syndrome, is becoming a disease that strikes nurses harder than anyone else. doctors accounted for many of the initial patients here, as they became infected while checking the throats of patients and performing other clinical diagnostic tasks. but as blood tests and other means for identifying patients have emerged, doctors have spent less time close to infected patients.

    nurses, however, have been falling sick in large numbers. according to the hong kong hospital authority, nurses now make up 55 percent of the 368 health care workers who have had confirmed cases of sars here over the last two months. doctors now account for just 15 percent of cases, a percentage that is steadily dropping as more nurses fall ill, while the remaining 30 percent of cases are among ward attendants, nursing assistants, cleaners and other workers at hospitals and clinics.

    sars is a major risk for nurses here even when they are performing their most routine tasks. for ms. pong, the most alarming moment since the sars outbreak began came a month ago, when an old woman suffering from dementia as well as sars lowered her face mask and coughed hard right at ms. pong. "it was a scary feeling," ms. pong said.

    nurses "are exposed to a much higher risk of infection than doctors because usually the doctors do their rounds in the morning and in the afternoon, so they are in the ward for less than two hours," said dr. justin wu, a gastroenterologist here. "the nurses need to spend the whole day in the ward, looking after the patients."

    like ms. pong, dr. wu has been treating sars patients at prince of wales hospital, one of the city's best.

    some sars patients have become disorderly or even violent, either because of depression over their illnesses or because of pre-existing mental conditions. this has further increased the danger to nurses.

    "the patients pull down their face masks and even vomit their food on the nurses," dr. wu said, adding that at least two nurses at prince of wales hospital had been infected when patients vomited on them.

    there are also more nurses than doctors in the pneumonia wards here, with 4,500 nurses caring for sars patients, compared with 1,300 doctors.

    the first health care worker to die here of sars was a nurse, lau wing kai, on april 26. his funeral wednesday was expected to draw many government officials. tung chee-hwa, hong kong's chief executive, ordered that he be buried at gallant garden, the cemetery for civil servants who die in the line of duty, even though mr. lau was technically not a civil servant because he worked for the hospital authority, a government-owned entity separate from the rest of the bureaucracy.
    at hong kong hospitals, sars takes a heavy toll on nurses
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    in addition to facing more risks than doctors, hong kong's nurses earn considerably less. the heavily unionized nurses at public hospitals typically earn about $38,000 a year, while staff doctors at the same hospitals earn close to $80,000, said joseph lee, the chairman of the association of hong kong nursing staff, the union that represents two-thirds of the territory's 30,000 nurses.

    ms. pong said that she had no regrets about becoming a nurse despite the difficulties of the last two months. she decided that she wanted to be a nurse at the age of 7 because she wanted to help people, and says she never wavered about what she wanted to do with her life.

    sars patients frequently become deeply depressed at their steep physical decline, and relieving that depression is as important in some ways as curing their bodies, ms. pong said.

    "i'm a cheerful person and outgoing," she said, "and i feel that i can make them feel better."

    while caring for sars patients remains scary, it is not as terrifying now as it was in mid-march, when dozens of ms. pong's colleagues suddenly began falling ill.

    the early stages of the illness were the worst because of the uncertainty, ms. pong said. "we didn't know what precautions to take," she added.

    to make matters worse, infection-control equipment was in short supply, and nurses had to use the same thick masks for long periods of time, a practice that could lead to the masks becoming heavily coated with viral particles and especially dangerous to touch.

    but conditions have improved in the last several weeks. medical supplies have increased, ms. pong said. and contrary to the fears of health professionals several weeks ago, it is now clear that the virus that causes sars is not capable of staying airborne for long periods of time like a flu virus. sars appears to spread most of the time through close personal contact, but scientists suspect it may also be transmitted through sewage and by rodents.

    in the first weeks here, a constantly growing tide of people was swamping wards and intensive-care units and almost no one was recovering. but more than half the people infected in hong kong have now recovered, while a 10th have died and the rest are still in hospitals.

    perhaps most important for the long term, the rate of new infections here has dropped strikingly, showing that it is possible to control sars, at least in a city with modern medical facilities.
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  3. by   toronto rn
    I cannot imagine the toll SARS is taking on the nurses in china. We are nearing the end of our scare, but theirs may continue on indefinitely. The following is a nurses' story of her struggle with SARS. There are many other health care workers out there who have also suffered, including paramedics, RRT's and Physicians. We can only hope China gets the help it needs to eradicate SARS or we may well be dealing with a more virilent strain next year.

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    'I didn't think I was going to make it'

    Chris Nuttall-Smith
    CanWest News Service

    Friday, May 02, 2003

    CanWest News Service / Eight-year-old Samantha Sorrenti (left) cuddles up with her mother Susan next to Angela, 6, and Gregory Smith outside their home in Peterborough, Ont.

    At 5:30 on a Friday morning, Susan Sorrenti woke up, alone, and took her temperature.

    In the early days of Toronto's outbreak of severe acute respiratory syndrome, Sorrenti, a nurse at the city's Mount Sinai Hospital, had helped admit a patient with pneumonia. Like her colleagues working that shift, she hadn't thought the patient had SARS. For those first few minutes of contact, she had not worn gloves. A few days later, the hospital called her at home, telling her to put herself into quarantine.

    Sorrenti, 39, is a wife, the mother of two little girls, and her family's breadwinner. For years she had supplemented her full-time nursing job with extra shifts, so she often worked 60 hours a week, commuting the 90 minutes each way.

    Now she had to shut herself into a room, and she had to yell through the door to communicate with her husband, Greg Smith, and children Angela, 6, and Samantha, 8.

    She used disposable plates, glasses and utensils, separate linens and a separate washroom. Each time she made the trip from her room to the washroom, she would call out to her girls, to tell them to go to their rooms and shut the doors, and she'd scrub every door handle and light switch she touched with a disinfectant wipe. The girls would beg for her affection. "Mommy, why can't you give me a kiss good night? I just want a hug."

    She took her temperature all the time, hoping not to show a fever, one of the early symptoms of SARS.

    For the first few days, nothing.

    And then, this morning of Friday, March 28, at 5:30. Sorrenti was still in bed when she pulled the thermometer from her mouth. She stared at the digital reading. 38.1 degrees.

    She called Peterborough's public health department, and her hospital.

    That morning, a promised shipment of respiratory masks arrived at the home. She donned a mask, and told her girls from a distance, "Mommy's got to go now." She could only wave goodbye.

    The two little girls did what they could.

    "When I left, my little girls had written 'I love you mom' in the dirt on my car, with a great big heart," Sorrenti recalled. "It broke my heart. I almost broke down right there. But I kept driving."

    She could not have imagined then that she would almost die.


    Her room at Mount Sinai was on the 17th floor, with a view of Lake Ontario. It was sealed off from the rest of the hospital with negative air pressure so floating pathogens could not escape. Sorrenti had to don her respiratory mask each time a doctor or nurse entered. The medical staff did not enter without masks, gloves and gowns.

    On that Friday, they took blood for tests and x-rayed her chest to see if her lungs had taken on fluid. She was still feeling fine, and the tests did not turn up anything.

    Doctors started Sorrenti on levofloxacin, a powerful antibiotic, and prednisone, a steroid, to protect her lungs from inflammation.

    Sorrenti's admission to hospital brought on another problem: her husband, Greg, had found work two weeks earlier, after three years of looking. But now, he might be infected, as might their daughters. And he still had trouble believing it.

    "He wasn't going to respect the quarantine. He was determined to go back to that job," she recalled. She reported him to Peterborough's public health department.

    Sorrenti stared out at the dingy yellow hospital walls and wished. "I was hoping I would be one of the people who would just develop a fever then get sent home."

    On Saturday, the worst thing she felt was anxiety. She called home at least five times that day to ask her husband if he or the children had a temperature. They were fine, he told her.

    By Sunday, Sorrenti began to feel hot and uncomfortable. Her fever climbed to 38.7 degrees.

    She had been hoping she could avoid taking the anti-viral drug that doctors had been using to treat SARS patients. The drug was most often used to fight hepatitis C and hemorrhagic fever, and it could cause birth defects, organ damage and the breakdown of blood cells. But her resistance began to wane.

    "Sunday I started to get worse. I started to feel like maybe if I didn't get better soon I was going to start to take the ribavirin."

    The illness crept through her. It began to take control. By Monday, Sorrenti's temperature climbed to 39.5. She began to feel short of breath. She got sick now, too, with nausea and vomiting. She couldn't eat. She worried about her fever. She began to shake uncontrollably, just a little at first. The doctors started her on ribavirin, the anti-viral drug. For the first time in her life, Sorrenti faced the possibility that she might die. She called her husband, to figure out a will, and to start making arrangements.

    It had been nine days since her exposure to that SARS patient, and on Tuesday, her x-ray turned up more unsettling news. Her lungs had begun to fill with fluid. Blood tests showed that her blood was slowly losing its ability to deliver oxygen around her body. "I was huffing and puffing just lying in the bed turning from side to side."

    She started on omeprazole, a drug to prevent stress-induced stomach ulcers. She began taking lorazepam, an anti-anxiety drug. She took mineral supplements to restore electrolytes to her body.

    The shaking grew worse. Her doctors increased her dosage of steroids -- a sign, she believed, that the disease was out of control. The steroid took its toll on her emotions. "The whole experience was already stressful, then to have these massive amounts of this particular drug ... I was actually feeling that I was losing my mind."

    Back in Peterborough, Greg Smith had set up a school in the family's computer room, ringing a dinner bell for recess and lunch each day, and finishing class at 3 p.m. But now he realized his wife was seriously ill. "As I was telling him that I was getting sicker and being very weak and basically not having much breath to talk to him on the phone, he was -- I think one of my children said that she came into his room in the middle of the night and he was crying."

    She did what she could to care for herself. She started using oxygen to help her breathe, inserting the two prongs in her nostrils and turning the dial herself when she needed it. She was a nurse, after all. She started coughing, just a little; a dry "non-productive" cough -- just what all the news reports listed as a symptom of SARS.

    The telephone and the television had become just about her only diversions. Yet the television news only reinforced her own fears. She watched as the SARS death toll began to mount. One time, the television droned on, and Sorrenti wanted badly to turn it off. She couldn't summon the energy to reach for the controller. She could hardly stop vomiting, and a new problem grew more and more agonizing: all the medicine constipated her. It got painful.


    Thursday, April 3, might well have been the worst day of Susan Sorrenti's life. It began around 1 a.m. "I remember going into the washroom because I needed to be sick, and I missed the toilet," she said. "I got it on the floor, and then I remember just kind of -- I remember being on the floor."

    Three nurses came to clean her up. They changed Sorrenti's bed sheets, which had soaked through. Her temperature hit 39.7 degrees.

    The nurses left her in bed, alone again, in pain, deadly sick and feeling desperate. In these seven days so far no one but hospital staff had been allowed to visit her. At 3:30 that morning, she picked up the telephone to call Peterborough. Her husband answered. "I told him I didn't think I was going to make it through the night."

    Later that morning, Sorrenti learned that one of her colleagues, another nurse from her unit, had also developed SARS. She became more depressed.

    Until then, Sorrenti had resisted taking a full dose of sedatives. As a nurse, she knew that they could get addictive. "At that point I gave up," she said. "I said, 'I'm going to take it as much as I can.'" It helped her through the day.

    She remembers snippets of the next couple days: bits of television newscasts, crying, telephone calls to her colleagues from work. She thought of her daughters, and told them one day, struggling for breath, "Oh, Mommy's not feeling that well today. Can't talk very much. But I love you. And I'll see you soon." She remembers promising trips to restaurants, and to the zoo. Her fever dipped, then climbed again. Her friends offered consolation and pledges of prayers.

    "I was taking whatever reassurance I could from that, but deep down inside I just really basically knew that nobody knew what to do."


    Then, the break. On Saturday, April 5, eight days after she had driven herself to the hospital, Susan Sorrenti started feeling slightly better. Her breathing got easier, and now she could walk on her own to the bathroom. After six days' constipation, she finally got relief.

    Her lungs continued to clear, though. She felt better on Sunday, then better still on Monday, when her x-ray showed her lungs were on the mend. Her fever finally came under control.

    And she heard great news from her family in Peterborough. By Monday, they had spent 10 full days in quarantine, and neither her daughters nor her husband had developed any symptoms of SARS.

    Her recovery took another full week of constant nausea and of swallowing pills, and of staring out her hospital room window, watching storms on Lake Ontario below her, and tail lights slicing through the midnight pall.

    "It was just the longest period of time that I can ever remember in my life. It was just dreadfully, painfully slow. I would look out the window, walk around, and talk to myself sometimes. Basically, chair to the bed, to the chair, to the bed, to the chair, to the bed."

    She forced herself to eat. Slowly, her doctors weaned her off the steroids. Then that Sunday, they told her she might be able to leave the next day.

    "Monday morning at five, I got up and took a shower. I stripped my bed down of all the linens, I took all my possessions, threw out what I knew I wasn't going to bring home and just -- I was packed and ready to go."

    Greg Smith took the Greyhound from Peterborough and arrived around noon. Monday, April 14 was a crisp, sunny day. Susan stepped into some of the freshest air she could ever remember.

    She collapsed into the passenger seat of her car, where she saw that message her two daughters had written in the road dirt on the hood 18 days earlier. Soon enough, she would ride home with the window open, as if she couldn't possibly get enough fresh air after so much time spent inside.

    It would take her weeks to walk without getting winded, and it will take more time than that to persuade herself that she can safely return to work -- she is still too afraid to this day, she said.

    But on that Monday at noon, with the air fresh and crisp and her husband now before her, Susan Sorrenti walked toward him.

    "I was free. I was out of there," she recalled. "I just grabbed on to him and sobbed. I just couldn't help it. I went right up to him and I just put my arms around his shoulders, put my head on his shoulder and just sobbed."

    Copyright 2003 Vancouver Sun
    Last edit by toronto rn on May 8, '03
  4. by   oramar
    God bless everyone dealing with this hands on. They should have a wall of hero's just like for the soldiers.
  5. by   Scotty
    That made me shed a tear or few. I'm just glad Ms Sorrenti is recovering. I really admire you nurses who are dealing with this. Stay safe.